Division of Cardiology, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Curr Cardiol Rev. 2024;20(3):77-86. doi: 10.2174/011573403X276984240304044109.
Over 750,000 individuals suffer from stroke annually in the United States, with 87% of these strokes being ischemic in nature. Roughly 40% of ischemic strokes occur in individuals 60 years of age or under. A quarter of all ischemic strokes have no identifiable cause despite extensive workup and are deemed cryptogenic in nature. Patent Foramen Ovales (PFO) has been postulated in stroke causation by either paradoxical embolization or platelet activation in the tunnel of the defect. The incidence of PFO is reported to be 15-25% in the general population but rises to 40% in patients with cryptogenic stroke. While the initial trials evaluating PFO closures were non-revealing, subsequent long-term follow-ups, as well as recent trials evaluating PFO closures in cryptogenic stroke patients 60 years of age or under, demonstrated the superiority of percutaneous closure compared to medical therapy alone, leading to FDA approval of PFO closure devices. In this review, we review the diagnosis of PFO, postulated stroke mechanisms, literature supporting PFO closure, patient selection for percutaneous closure, procedural considerations, and associated procedural complications.
每年在美国有超过 75 万人患有中风，其中 87%属于缺血性中风。大约 40%的缺血性中风发生在 60 岁或 60 岁以下的人群中。尽管进行了广泛的检查，但四分之一的缺血性中风仍然没有明确的病因，被认为是隐源性的。卵圆孔未闭（PFO）被认为是中风的原因，可能是通过反常栓塞或缺陷隧道中的血小板激活。PFO 的发病率在普通人群中为 15-25%，但在隐源性中风患者中上升至 40%。虽然最初评估 PFO 封堵的试验没有显示出效果，但随后的长期随访以及最近评估 60 岁或以下隐源性中风患者 PFO 封堵的试验表明，与单纯药物治疗相比，经皮封堵具有优越性，这导致了 FDA 对 PFO 封堵设备的批准。在这篇综述中，我们回顾了 PFO 的诊断、推测的中风机制、支持 PFO 封堵的文献、经皮封堵的患者选择、程序考虑因素以及相关的程序并发症。
